Join NYMGMA - Medical Group Management Association

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NYMGMA - An organization supporting practice management professionals within New York State

NYMGMA Sponsor Membership Application

This application for Sponsor membership in the New York Medical Group Management Association (NYMGMA) indicates the Sponsor’s willingness to abide by the conditions outlined in NYMGMA policy on sponsorship from vendors.

Please Indicate:

New Member Renewal

Sponsor Member Information

Contact Person:

Name of Firm:

Address:

Addres 2:

City/State/Zip

Phone Number:

Fax Number:

Email Address:

Confirm E-amil:

Service Description:
(25 words or less)

Service Category:

Please Select	Fee	Level	Sponsor Level Benefits
	$900/yr	Gold	Listed in and have access to our on-line membership directory. Opportunity to exhibit in a prime location at our annual State conference and at three anticipated regional state events. (including the opportunity to see space layout of the exhibit area and choose location in advance). Ability to send one representative to each State and Regional Conference at no charge. (Booth space will be purchased separately and additional representatives will need to pay the conference fee). Have the ability to purchase advertising space in the newsletter. Be listed on the Gold member page of our website www.nymgma.com, including a direct link to your designated vendor site (including graphics and an email option from that page, subject to review by our web master). Have a 25 word description of your company’s services listed on the vendor page of the website along with your listing.
	$600/yr	Silver	Listed in and have access to of our on-line membership directory. Opportunity to exhibit at our annual State conference and at three anticipated regional state events (if space permits). Ability to send on representative to each State and Regional Conference at no charge. (Booth space will be purchased separately and additional representatives will need to pay the conference fee). Have the ability to purchase advertising space in the newsletter. Have your organization listed on the web site (contact name, phone number, and email).
	$300/yr	Bronze	Listed in and have access to our on-line membership directory. Opportunity to exhibit at our annual State conference (if space permits). Have your organization listed on the web site (contact name, phone number, and email). Have the ability to purchase advertising space in the newsletter

Please indicate how you will be submitting payment below. Following submission of your on-line application, you will be re-directed to our Sponsor Policy page, where you will need to review, print, sign and then return this form to us along with your payment. Be sure to let us know your plans for vendor participation.

By Check - Please mail your check made payable to NYMGMA to:

New York MGMA
30 Jericho Turnpike, #170
Commack, NY11725

Phone (631) 864-1960
Fax (631) 864-8397

Credit Card Payments can not be taken at this Time